Gabriele Armbrecht1, Dieter Felsenberg1, Melanie Ganswindt1, Mark Lunt2, Stephen K Kaptoge3, Klaus Abendroth4, Antonio Aroso Dias5, Ashok K Bhalla6, Jorge Cannata Andia7, Jan Dequeker8, Richard Eastell9, Krzysztof Hoszowski10, George Lyritis11, Pavol Masaryk12, Joyce van Meurs13, Tomasz Miazgowski14, Ranuccio Nuti15, Gyula Poór16, Inga Redlund-Johnell17, David M Reid18, Helmut Schatz19, Christopher J Todd20, Anthony D Woolf21, Fernando Rivadeneira13, Muhammad K Javaid22, Cyrus Cooper22, Alan J Silman22, Terence W O'Neill22, Jonathan Reeve22. 1. Department of Radiology and Nuclear Medicine, Free University, Berlin, Germany. 2. NIHR Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, & Arthritis Research UK Centre for Epidemiology, Manchester, University of Manchester. 3. Department of Public Health and Primary Care, Strangeways Research Laboratory, Cambridge, UK. 4. Klinik fur Innere Medezin IV, Jena, Germany. 5. Rheumatology, Hospital de San Joao, Oporto, Portugal. 6. Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK. 7. Nephrology, Asturias General Hospital, Oviedo, Spain. 8. Rheumatology, University Hospital, Leuven, Belgium. 9. Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK. 10. Medicine, PKP Hospital, Warsaw, Poland. 11. Laboratory for the Research of Musculoskeletal System, University of Athens, Athens, Greece. 12. Rheumatology, Institute of Rheumatic Diseases, Piestany, Slovakia. 13. Department of Epidemiology and Department of Internal Medicine, Erasmus University, Rotterdam, Netherlands. 14. Department of Hypertension and Internal Medicine, Pomeranian Medical University, Szczecin, Poland. 15. Institute of Clinical Medicine, University of Siena, Siena, Italy. 16. 1st Department of Rheumatology and Metabolic Osteology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary. 17. Orthopaedics and Radiology, Malmö General Hospital, Malmö, Sweden. 18. School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK. 19. Rheumatology, Med Klinik & Polyklinik, Bochum, Germany. 20. School of Health Sciences, The University of Manchester, Oxford Road, Manchester. 21. Institute of Health Care Research, Peninsula College of Medicine and Dentistry, Universities of Exeter and Plymouth, Royal Cornwall Hospital, Truro. 22. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculo-skeletal Biomedical Research Unit, Botnar Research Centre, Oxford, UK.
Abstract
Objectives: To assess the prevalences across Europe of radiological indices of degenerative inter-vertebral disc disease (DDD); and to quantify their associations with, age, sex, physical anthropometry, areal BMD (aBMD) and change in aBMD with time. Methods: In the population-based European Prospective Osteoporosis Study, 27 age-stratified samples of men and women from across the continent aged 50+ years had standardized lateral radiographs of the lumbar and thoracic spine to evaluate the severity of DDD, using the Kellgren-Lawrence (KL) scale. Measurements of anterior, mid-body and posterior vertebral heights on all assessed vertebrae from T4 to L4 were used to generate indices of end-plate curvature. Results: Images from 10 132 participants (56% female, mean age 63.9 years) passed quality checks. Overall, 47% of men and women had DDD grade 3 or more in the lumbar spine and 36% in both thoracic and lumbar spine. Risk ratios for DDD grades 3 and 4, adjusted for age and anthropometric determinants, varied across a three-fold range between centres, yet prevalences were highly correlated in men and women. DDD was associated with flattened, non-ovoid inter-vertebral disc spaces. KL grade 4 and loss of inter-vertebral disc space were associated with higher spine aBMD. Conclusion: KL grades 3 and 4 are often used clinically to categorize radiological DDD. Highly variable European prevalences of radiologically defined DDD grades 3+ along with the large effects of age may have growing and geographically unequal health and economic impacts as the population ages. These data encourage further studies of potential genetic and environmental causes.
Objectives: To assess the prevalences across Europe of radiological indices of degenerative inter-vertebral disc disease (DDD); and to quantify their associations with, age, sex, physical anthropometry, areal BMD (aBMD) and change in aBMD with time. Methods: In the population-based European Prospective Osteoporosis Study, 27 age-stratified samples of men and women from across the continent aged 50+ years had standardized lateral radiographs of the lumbar and thoracic spine to evaluate the severity of DDD, using the Kellgren-Lawrence (KL) scale. Measurements of anterior, mid-body and posterior vertebral heights on all assessed vertebrae from T4 to L4 were used to generate indices of end-plate curvature. Results: Images from 10 132 participants (56% female, mean age 63.9 years) passed quality checks. Overall, 47% of men and women had DDD grade 3 or more in the lumbar spine and 36% in both thoracic and lumbar spine. Risk ratios for DDD grades 3 and 4, adjusted for age and anthropometric determinants, varied across a three-fold range between centres, yet prevalences were highly correlated in men and women. DDD was associated with flattened, non-ovoid inter-vertebral disc spaces. KL grade 4 and loss of inter-vertebral disc space were associated with higher spine aBMD. Conclusion: KL grades 3 and 4 are often used clinically to categorize radiological DDD. Highly variable European prevalences of radiologically defined DDD grades 3+ along with the large effects of age may have growing and geographically unequal health and economic impacts as the population ages. These data encourage further studies of potential genetic and environmental causes.
Keywords:
Kellgren–Lawrence grading; age range 50 plus years; bone mineral density (BMD); degenerative disease; intervertebral disc; multi-centre prevalence study; osteochondrosis intervertebralis; plane radiology; population-based; reproducibility study
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